Bernard Fisher, MD, challenged status quo to help save the lives of many affected by breast cancer
Updated: Nov 9, 2019
Breast cancer treatment has improved dramatically over the past 60 years, and without the advances made by those such as Bernard Fisher, MD, who died on Oct. 16 at the age of 101, we would not be where we are today.
Fisher pioneered the design and implementation of large-scale multi-center randomized clinical trials, Not only did did his studies lead to the use of tamoxifen to prevent breast cancer in high-risk women, but years earlier, they also provided a scientific basis for less extensive surgeries for the treatment of breast cancer. In 1971, Fisher led the National Surgical Adjuvant Breast and Bowel Project (NSABP) in a landmark clinical trial in women with primary breast cancer comparing radical mastectomy with less extensive total mastectomy.
Then in 1976, he led a study to compare the effectiveness of the radical mastectomy with less intrusive lumpectomy, with or without irradiation. Prior to Fisher's studies, a radical mastectomy, which removed the diseased breast, lymph nodes and chest wall muscles, was the norm for treatment of breast cancer.
However, the research that Fisher led showed no advantage in survival rates with the more extensive surgery, according to the University of Pittsburgh, where Fisher attended medical school and later joined the faculty. He was the first full-time member of the department of surgery, established the first laboratory of surgical research at the university and was named Distinguished Service Professor for the school of medicine.
Fisher challenged the status quo
Fisher's approach to medical care of those with breast cancer challenged the way of thinking for some physicians, who met his ideas with opposition, according to The New York Times. In fact, the newspaper reports that in order to test his hypothesis that a radical mastectomy may be no better at saving the lives of those with breast cancer than would be a simple mastectomy (in which only the breast is removed) he was forced to turn to Canada, as US surgeons would not enroll their patients in his clinical trial, according to The New York TImes. As a result, Fisher relied upon additional surgeons and patients at Canadian academic medical centers to take part in his clinical trial.
Ultimately, he found that the women within three groups of his study showed no difference in cancer recurrence, metastasis to distant parts of the body or death rates, the newspaper reports. One of the groups was comprised of women who had a radical mastectomy, another included women who had a single mastectomy, and the third was full of women who had a single mastectomy followed by radiation.
“Dr Fisher’s iconic status in breast cancer research and treatment derived from his ability to envision a world not constrained by his surroundings, and current clinical practice at that time," says Robert Ferris, M.D., Ph.D., director of the University of Pittsburgh Medical Center's Hillman Cancer Center. "He questioned the status quo, challenged it in the most rigorous scientific fashion, and changed practice for the betterment of women everywhere."
The capstone of Fisher's career
Fisher also led studies that showed the addition of systemic, adjuvant chemotherapy or hormonal therapy provided a survival advantage over surgery alone. Based on these studies, Fisher and the NSABP initiated the first trial to test tamoxifen for breast cancer prevention in 1992.
The trial showed that tamoxifen decreased the incidence of breast cancer and could be used for many women at increased risk for the disease. “Our 1998 report indicating, for the first time, that breast cancer could be prevented with tamoxifen was probably the capstone of my career," Fisher told Pitt Med Magazine. "Certainly, in 1958, when I began this journey, the idea of using an agent to try to prevent breast cancer was . . . science fiction.”